LAUSR

Moste-cigarettes contain nicotine in various “doses,” and the public health message is very clear: If you start using aerosol nicotine (vaping), you are at risk of developing an addiction to nicotine, a powerfully reinforcing drug. The neurobiological basis for nicotine addiction results from its reinforcing properties in the brain, mechanisms that produce cravings, and high levels of anxiety relieved only by using more nicotine. As with other addicting drugs, dopamine is released with every puff activating the mesolimbic dopamine reward system neurons. The brain learns, through repeated use, to seek nicotine to get the same “reward.” Along with the dopamine reward mechanism, acetylcholine neuroreceptors get “hijacked” by nicotine, and the brain becomes controlled by them (Stahl, 2013). After only four puffs of a cigarette or e-cigarette, the nicotinic receptors are 95% full, yet most people smoke an entire cigarette or manymore inhalations of an e-cigarette (Stahl, 2013). Flavors that are added to e-cigarettesmake their use evenmore attractive and may increase the dopamine surge. Sweet flavors act in the brain's dopamine signaling mechanism to increase the amount of nicotine used (Wickham et al., 2018) when tested in rats. The Centers for Disease Control and Prevention (CDC) and Food and Drug Administration (FDA) found increasing use of flavored e-cigarettes in high school students in 2014–2018 and in middle school students in 2015–2018 when analyzing data from the 2014–2018 National Youth Tobacco Surveys (Cullen et al., 2019). FDA regulations and individual states' regulations must act to limit the flavor additives to e-cigarettes. Nicotine by classification is a stimulant. It can boost energy and cause mild euphoria, and yet it can calm anxiety, curb hunger, and reduce pain. It is unique in its ability to react to the state of the individual. Nicotine withdrawal symptoms, as discovered in rat research, occur as a result of corticotropinreleasing factor activation (CRF-CRF1) in the central nucleus of the amygdala, creating a powerful stressor (anxiety) that is relieved by increasing amounts of self-administration of nicotine, making nicotine addiction very difficult to treat and abstinence difficult to sustain (George et al., 2007). The good news is that nonnicotine medications may help block the activation of the CRF-CRF1 system. There are several reasons why nicotine is so reinforcing. Nicotine stimulates the release of dopamine in the nucleus accumbens, prefrontal cortex, amygdala, hippocampus, and other